1 Pendidikan Pendidikan - - Dokter umum FK UNSRI Palembang Dokter umum FK UNSRI Palembang - Internist FK UNPAD Bandung Internist FK UNPAD Bandung - Subspesialis Reumatologi FK UI Subspesialis Reumatologi FK UI Jakarta Jakarta - Clinical Rheumatology and - Clinical Rheumatology and Osteoporosis Training – Perth - Osteoporosis Training – Perth - WA WA Rachmat Gunadi Wachjudi Rachmat Gunadi Wachjudi Lahir di Garut 16 Januari 1955 Lahir di Garut 16 Januari 1955 Pekerjaan Pekerjaan Ka Div Reumatologi Ka Div Reumatologi Departemen Ilmu Penyakit Dalam Departemen Ilmu Penyakit Dalam Rumah Sakit dr Rumah Sakit dr Hasan Sadikin Bandung Hasan Sadikin Bandung Organisasi: IDI, PAPDI, IRA, PEROSI, PERALMUNI
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
PendidikanPendidikan
- - Dokter umum FK UNSRI PalembangDokter umum FK UNSRI Palembang
-Internist FK UNPAD BandungInternist FK UNPAD Bandung
-Subspesialis Reumatologi FK UI Subspesialis Reumatologi FK UI JakartaJakarta
- Clinical Rheumatology and - Clinical Rheumatology and Osteoporosis Training – Perth - WAOsteoporosis Training – Perth - WA
Rachmat Gunadi WachjudiRachmat Gunadi WachjudiLahir di Garut 16 Januari 1955Lahir di Garut 16 Januari 1955
PekerjaanPekerjaan
Ka Div ReumatologiKa Div Reumatologi
Departemen Ilmu Penyakit Dalam Departemen Ilmu Penyakit Dalam Rumah Sakit dr Hasan Sadikin Rumah Sakit dr Hasan Sadikin BandungBandung
Organisasi: IDI, PAPDI, IRA, PEROSI, PERALMUNI
Comprehensive Management of
Autoimmune Disordersin Internal Medicine
Rachmat Gunadi WachjudiPerhimpunan Reumatologi Cabang Bandung
3
The Basics
• Autoimmunity occurs when the body is unable to differentiate “self” from “non-self”
–Results in overactive immune response against own cells and tissues
• Affects 5%-8% of the population
–78% affected are females
• Over 100 conditions linked to autoimmunity
–15 diseases directly linked to autoimmune response
44
55
6
Pathogenesis of Autoimmunity
• Genetic predisposition and environmental factors relevant
– Immunoglobulins, T cell receptors, major histocompatibilty complex
• T Cell Bypass- The requirement of T cells to activate B cells in order to produce large amounts of antibodies is bypassed
• Molecular Mimicry- An exogenous antigen shares structural similarities with host antigen and when an antibody is produced, it can bind to host antigen
• Idiotype Cross Reaction- A cross reaction between the idiotype (molecule recognized by antigen) on an antiviral antibody and a host cell receptor for the virus in question
• Cytokine Dysregulation- Certain cytokines have a role in the prevention of the exaggeration of pro-inflammatory immune response
• Dendritic Cell Apoptosis- Defective dendritic cells can lead to inappropriate systemic lymphocyte activation and a decline in self tolerance
7
Symptoms
• Tiredness
• Depression
• Weight gain
• Weight loss
• Muscle weakness
• Cramps
• Irritability
• Sweating
• Shaky
• Swelling
• Rash
• Body pains
• Tremors
• Numbness
• Fatigue
• Loss of appetite
• Insomnia
• Coordination loss
Many different symptoms make autoimmune disorders hard to diagnose
Many times there are no symptoms!
8
Workup
• History and Physical
• Markers of inflammation (ESR, CRP)
• Markers of immune activation (C3/C4)
• Imaging studies (hand/foot radiographs)
• Synovial fluid analysis
• Autoantibody testing
• Diagnostic criteria of 103 AID
9
Autoantibody Tests
• ANA
• DS-DNA
• RF
• CCP
• Ro/La
• Jo
• Scl-70
• RNP
• Anti-Histone
• P-ANCA
• C-ANCA
• Anti-GBM
• ASCA
• ASMA
• LKM
• AMA
• ACE
• TTG
10
Dysthyroïdies Arthritis RA/JIA
Sjögren
PM DM CBI
Scleroderma vasculitis
SLE
11
The impact of debiltating diseases SLE
Dermatomyositis
PolymyositisUndifferentiated CTD
Sjogren’s syndrome
Scleroderma
12
The impact of autoimmune disorders…….
13
Clinical Features related to disability
• Constitutional and multisystem effects
• Chronic, no cure
• Exacerbations (flares) and remissions unpredictable but usually treatable
• Treated with immunosuppressive medications – side effects
• Comorbidities due to organ damage, to medication side effects, to long term disease/treatment effects and to other factors (eg psychological)
Other treatmentsOther treatments Helminthic therapyHelminthic therapy inoculation of the patient with specific parasitic
intestinal nematodes
Radiation of the lymph nodes and plasmapheresis
Treatment for the deficiency Treatment for the deficiency - for example, insulin injections in the case of for example, insulin injections in the case of
diabetes. diabetes.
31
Features of autoimmune disorderswhich can lead to disability
• Related to disease activity
– constitutional
– structural organ effects
• Related to medication effects
• Functional changes “related to AID” but not to active disease**
• Cohort of 159 patients with SLE working since diagnosis (Partridge et al: Arthritis Rheum 1997; 40:2199)
– 40% quit work completely average of 3.4 years after diagnosis
– substantial job modifications
– predictors of early work disability – lower education status (no college), health insurance status, physical rather than mental job, low income, greater disease activity at time of diagnosis
• Inception cohort of 273 SLE patients (Bertoli et al: Ann Rheum Dis 2007; 66:12)
- 19% self-report of disability at 5 years (25% in AA)
- predictors – age*, longer disease duration, male, poverty*, less social support, higher disease activity and damage index